What Are Shin Splints - Part 3

So I've talked about nomenclature and causes of shin splints. Now it's time to get into the prevention and treatment of shin splints.

Prevention


"Running Shoes" by barbourians
As always, prevention is the best medicine. Following some simple guidelines for exercise may help you stave off shin splints. For example, if you're picking up running again for the first time is months/ years or a completely new runner ease yourself into it. Don't go out on your first day and try to run 3km. You'll likely struggle to do it and your body will pay for it later. Learnt to pace yourself and have a progressive exercise routine. With that in mind, always have an adequate warm up and cool down when exercises. this will prepare your musculoskeletal and cardiovascular system for the higher-intensity as well as gradual bringing them back to a resting state. Speaking of rest. You need it. Give your muscles time to repair! I know the whole "no pain, no gain" attitude, but sometimes you just have to listen to your body. These are simple things that will help prevent any injury, not just shin splints.

Aside from that, one of the common causes of shin splints is improper footwear. You're going to want to get yourself a good pair of running/training shoes for over-pronation. I'm not going to try to steer you in one direction or the other with regards to brands because they all have something to offer. Just look for a lightweight pair, with adequate arch support (to prevent overpronation) and also a heel post. I'm not an expert on footwear, but these are basics things. Get help from an in-store associate. You should also realize that running shoes wear out. replace them every 6 months at least or every 600-800km (400-500miles) Alternatively, if you're willing to shell out a little extra cash, many physiotherapist and podiatrist will be able to set you up with a custom orthotic. Check with your local health professionals for more information.

Treatment


If you're already suffering from shin splints then the above mentioned preventative measures can still help, but they're unlikely to solve the entire problem. Given that shin splints are more often than not considered an overuse injury then they should be treated like any other tendonitis.

In the actue stage rest will be most important in treating shin splints. Some literature even suggests that cessation of sport for 2-6 weeks may be required. This is probably one of the hardest pills to swallow for most. I've had patients who were just unable to rest because of a compulsion to run. They would routinely report to me that they just went for a "short run." These are the ones who suffered through the pain longer than the ones who were able to slow things down and take a period of rest. Now, I'm not saying you have to completely give up activity. I am saying you should work with a physical therapist who can help tailor a progressive return to activity plan with you. 

Other than rest the main goal, as will any tendinitis, will be to control inflammation the rest will help with this, as will ice. I typically recommend ice following activity for 15 minutes on, 15 minutes off for 1 hour. A physical therapist can also use modalities such as ultrasound to help control inflammation. The use of NSAIDS, such as ibuprofen, can also be beneficial. 

Once inflammation can be controlled you can start with rehabilitation, which will involve modifying your workouts, being educated on prevention, as well as strengthening/flexibility training. Strengthening of the anterior tibialis, and stretching of the calf will be the mainstay of strength and flexibility training. Many studies support the use of eccentric strengthening of the calf and stretching of the calf in the treatment of shin splints.

Having a physical therapist analyze your gait (how your run/walk) as well as do a full lower body physical assessment with also help in recognizing any other deficits that may be attributing to the injury. Your physical therapist can then develop a rehabilitation program focused on these deficits which may or may no include strengthening of your core, gluteals, and hip musculature. A physical therapist may also use manual therapy techniques to help restore normal movement if the assessment warrants such intervention. A wide array of techniques can be used, which is beyond the scope of this article. 

There are other treatments such as acupuncture and steroid injections that may to be useful, however there are few studies to support whether or not these treatments work. If all else fails then surgery is the final option. While it would not be the first choice of treatment, it has been shown that a posterior fasciotomy can help reduce pain and improve function, but may or may not completely resolve the issue. 

Shin splints - or whatever else you want to call them - are a pain. No pun intended. They are difficult to treat and fully resolve, but if you can focus on prevention and getting help early on rather then waiting until the pain is unbearable, then they can be managed and cured. 


Do you have experience with shin splints? Tell me about it

Are you a physical therapist who has treated shin splints? What do you find most helpful?
How often do you change your running shoes?
Any other questions?
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References:

Galbraith, R. M and Lavallee, M. E (2009). Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine, 2(3), 127-133.

Thacker, S. B. et al. (2002). The prevention of shin splints in sports: a systematic review of literature.
Medicine and Science in Sports and Exercise, 34(1), 32-40.


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